HKU announces the first 10-year outcome study on effectiveness of early intervention on patients with psychosis Early intervention can reduce suicide rate by 60%

10 Jun 2013

Previous studies in other countries show that 5 to 10 out of every 100 patients with psychosis will commit suicide in their lifetime and their risk of suicide has been suggested to be about 8 times higher than general population. The Department of Psychiatry of The University of Hong Kong Li Ka Shing Faculty of Medicine carried out the first territory-wide 10-year outcome study on psychosis. The team analysed the rate of suicide and suicidal behaviour over 10-year period of 290 patients who either received the early intervention service (EI) or the standard care (SC) from 2000 to 2012. The findings eventually show that patients receiving the EI service have lower suicide rate than those under SC by 62%. It further upholds the presumption that the EI service on patients with psychosis can effectively decrease the suicide rate and suicidal attempt at a whole.

Research Implications
The leading researcher of this study, Professor Eric Chen Yu-hai, Clinical Professor and Head of the Department of Psychiatry, The University of Hong Kong Li Ka Shing Faculty of Medicine says, “Psychosis is a complex condition in which patients may experience hallucinations and delusions. The life time suicide risk for psychotic disorders is 5-10% and most of the suicides occur in the first few years of the disorder, according to previous studies. The study clearly points out that the EI service can significantly reduce the suicide rate with first episode psychosis patients by 62%. It is particularly impactful during the initial phase and its effect lasts longer than those under standard care service.”

Professor Eric Chen Yu-hai says that the results highlight the importance of the role of case manager. He adds, “The main duty of case managers is to follow up with the patients after onset of disease and provide tailor-made interventions to patients to improve their outcomes. The current standard of caseload of case manager is 1:50. It is still more than international standard, i.e. case load of 20-30 per case manager. If their case load can be further lessened, it is believed that the quality of service will be improved and may further improve the outcomes of the patients with psychosis.

Study method and findings
From 2010 to 2012, The Department of Psychiatry of HKU Li Ka Shing Faculty of Medicine conducted a historical control study to compare the 10-year outcomes of patients with first-episode psychosis who received early intervention service and those were under the standard care in order to evaluate the effectiveness of the EI service. Researchers selected two group of patients with psychosis who have received treatments since 10 years ago, i.e. the first group attended the Early Assessment Service for Young people with psychosis (the early intervention service named EASY, launched by Hospital Authority) for the first time were matched with those attended the standard psychiatric service under the Hospital Authority based on age, gender and diagnosis.

A total of 290 patients were identified (145 patients in each group) after matching. Face-to-face interviews were conducted to collect information including level of symptoms, current social and occupational functioning, medication and side effects of medication. All the available medical records of patients over the last 10 years were also reviewed to obtain information including the cause of death, suicidal attempts and hospitalizations. If patients found death within the period, researchers would also study their causes of death.

Over 10 years, the study shows that 15 out of 145 patients (10.3%) committed suicide in standard care group. For early intervention group, there were 6 out of 145 patients (4.1%) committed suicide. The EI service can thereby significantly reduce the suicide risk by 62% after taking gender into consideration.

In addition, patients in the EI group had a significant longer survival compared to SC patients. It implies that the EI service can reduce the suicide case at the early stage of illness. Among patients receiving the EI service, there were 21 of them having suicidal attempts whereas the number of patients under the SC service was 39. Comparing with two groups, the rate of suicidal attempts among the EI group is much lower than the SC group by 46%.

Suggestions
The study provides evidence on the effectivenss of early intervention service. Therefore an enhancement of current service should be encouraged. The extension of EI service to cover the prodromal period should also be considered. To do that, emphasis of public education specifically of the prodromal period should be encouraged.

This study also suggests the importance of case management intervention performed by case managers. Professor Eric Chen Yu-hai sees the needs for funding to enhance case manager as a profession both by increasing numbers and improving specific professional training.

About psychosis
Psychosis refers to a set of symptoms that include hallucinations, delusions and disorganized thoughts and speech. It is a psychological and physiological condition related to an imbalance in certain chemicals in the brain called “neurotransmitters”. Multiple aspects of a person’s life can be affected by this condition, including subjective experience, well-being, motivation, contact with reality and functioning. Symptoms can usually be effectively controlled by medications but more extensive psychological intervention is required to assure optimal outcomes.

In Hong Kong, the Early Assessment Service for Young people with psychosis (EASY) was launched in 2001 by Hospital Authority to provide phase specific intervention and aims to improve the long term effect of treatments, like reduction in suicide rate. In 2011, the EASY service has been extended to patients from age 15-25 to age 15-65 and two-year service was also extended to 3 years, providing territory wide service to patients with psychosis.

About research team
The research team is led by Professor Eric Chen Yu-hai, Clinical Professor and Head of the Department of Psychiatry, HKU Li Ka Shing Faculty of Medicine, in collaboration with Hospital Authority. The study is funded by Food and Health Bureau.

HKU announces the study on the effectiveness of early intervention service on psychosis patients in Hong Kong. The result shows that early intervention service can significantly reduce the suicide risk by 62% compare with standard care. From the left: Dr Sherry Chan Kit-wa, Clinical Assistant Professor; Professor Eric Chen Yu-hai, Clinical Professor and Head; and Ms Iris Chan Hiu-hung, Case Intervention Officer, Department of Psychiatry, HKU Li Ka Shing Faculty of Medicine.

Professor Eric Chen Yu-hai, Clinical Professor and Head, Department of Psychiatry, HKU Li Ka Shing Faculty of Medicine, says that, though early intervention (EI) service is effective, the suicide rate of psychosis patients with EI service is still high (4.1%). More resources are needed to reduce the case load of the case managers and further strengthen EI service.

Dr Sherry Chan Kit-wa, Clinical Assistant Professor of Department of Psychiatry, HKU Li Ka Shing Faculty of Medicine, suggests the service should extend further to patients with prodromal symptoms, because many psychosis patients do not even seek help from medical professional.

Ms Iris Chan Hiu-hung, Case Intervention Officer, Department of Psychiatry, HKU Li Ka Shing Faculty of Medicine, says that case managers keep close contact with each case of early intervention. Some patients will seek help from their case mangers when they experience difficulties, suicide might therefore be avoided with case managers’ intervention.